2019-03-03

Bleeding time and motion

I have a blood test every year, sometimes more often, and that means going to Heatherwood phlebotomy clinic.

They open at 08:30, and at that point there are typically 30 or more people waiting already (which is about capacity for the waiting room). They have numbered cards you take, and they call a number. If you are lucky then there are two of them taking blood.

First off, they really should have a second set of cards (maybe just for the first hour of the day), perhaps in red or something, for fasting blood tests. I was feeling hypo as it was, but had to wait over an hour to be seen. Luckily my test was not a fasting one, but had it been I could well have been collapsing. Normally a fasting test is not a problem for someone, but I have daily insulin, and that can mean some times I have to eat - such as when I have not eaten for 12 to 14 hours for a fasting test. Even though, in my case, it would have put people ahead of me in the queue - a priority queue for fasting would make sense. The blood test form says if fasting or not, so not like people could game the system and take the wrong card.

They are pretty efficient, check your name and DoB, strap arm, clean, find vein, take blood, tape dressing over it, and then spend about 50% of the overall time, or more, writing your name, and details (about 4 lines of text) on each of the blood sample containers (in my case, two).

It strikes me that the system could be massively better with a simple barcode readers and label printer. Even with nothing needing to be on-line, just a QR code on the blood form the doctor sends that when read provides the lines of text to print on the sample label, just that. Such a device would not be expensive (well, not compared to staff time over its operational life) and could mean processing at roughly twice the rate, by my estimate. A simple fall back to writing means not building in a dependancy on technology.

Of course the printed label could also have a QR code which probably then saves time when the samples are processed later, as well as reducing transcription errors.

Don't the NHS have people whose job it is to think of things like this?

P.S. I am surprised someone does not make a small label printer with QR reader that literally just prints the QR label content on a label on each scan. Must have loads of applications just like this!

9 comments:

  1. No. It has people at the top who listen to consultants and make huge changes almost at random every year or two to justify their existence (long before the system has adapted to the previous huge change), and right now a minister who listens to even more consultants and thinks that everything can be solved with Blockchain with a capital B.

    Everyone else is (more or less) too busy trying to do their jobs and adapting to the endless flow of top-down-enforced huge process changes to have time to think about local process changes that might actually make sense. (There are rare exceptions, but they are *way* too rare.)

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  2. Can't comment on the customer end (though a surgery I used to work for did print their own labels to go on samples of any type), but when the samples reach the lab they are usually labeled with a barcode of one type or another and loaded into a batch processing tray.
    So it would make sense to label them at the customer end but I guess that requires you to know what lab machine is going to be testing?

    Does sound like a good opportunity for standardising though

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    Replies
    1. It's hard to AVE common numbering schemes, especially for transient things like blood samples. This is quite common: parcels, bits of kit, airline luggage, anything that gets chain-handled seems to acquire more than one barcode label.

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  3. When I had to have very regular blood tests, I'd get to the hospital very very early - and even then there was a queue, and a pecking order!

    For some blood tests you get when in hospital, they'll actually be prepared enough to have sticky labels with all your details on ready for putting on the vials.

    QRs might be overkill and harder to scan on the curved surface of a small vial, however your NHS number and some binary coding as to the test(s) the sample is for would be sufficient for a 2D barcode.

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  4. My wife is expecting, and has a printed folder of paperwork she has to take with her to all her midwife appointments, ultrasounds, visits with her consultant etc.

    In the back of the folder is a page of printed sticky labels with a patient identifier (not her NHS number, for some reason) and a barcode. Every scan, blood sample, or bit of paperwork generated gets a barcode sticker on. Why something similar isn't used throughout the NHS baffles me - it saves so much time and reduces errors.

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  5. This is exactly the system the NHS has for blood donations. When you go up to start the donation they have a small sheet with a dozen or so barcodes with my ID on them, these then go onto the paper form, and all the test samples, and the main donation bag as well.

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  6. One of my jobs involves working with the NHS, we sell a system that can significantly increase their efficiency in a similar screening environment to blood testing.

    They are incredibly culturally resistant to efficiency savings. They are incredibly attached to writing things on paper then transporting the paper around even when it is already logged on screen.

    I've literally had NHS managers tell me "but if we save that much time I'll have to make someone redundant and they are my friends!"

    I think it is not helped by the fact that NHS managers are generally clinical staff, and, as someone whose wife is a Nurse, I'm very much aware that her degree included no form of management/supervisory type training, she just graduated and was expected to lead a team of support workers etc, and on promotion is expected to run a department etc, but all the ongoing development she goes through is clinical development, even as her job becomes less and less clinical through seniority.

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  7. The previous posts, and Adrian's comment are missing an important point.

    It is massively harder to make an error in a patient's details on the tube if they are handwritten.

    In fact for cross-match samples it is a mandatory requirement that the details are hand written for this reason.

    For other typres of sample there are usually small labels with patient details and often the labs will accept printed labels for these samples - BUT phlebotomy staff are not clinicians, they do not have the expertise, nor is it reasonable to expect them to have the expertise know which samples can use a pre-printed label and which need to be written out.

    So it is both common, and sensible, to have a blanket policy of handwritten details on sample tubes in these phlebotomy clinics.

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  8. Every time I go to give blood sample it's all printed with a barcode and everything. Once the label it's on it's all barcode based as far as I can tell.

    I guess it depends on the hospital.

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